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South Dakota rates for HCPCS J0202

Lemtrada IV SOLN 12 MG/1.2ML

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,429.89 / $2,429.89 / $2,429.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,429.89 / $2,953.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,475.75 / $2,475.75 / $2,475.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,487.56 / $3,109.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,440.69 / $4,124.78 / $4,881.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,440.69 / $2,717.01 / $10,655.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,138.38 / $3,115.03 / $4,067.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,138.38 / $2,928.84 / $3,115.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,528.26 / $2,659.13 / $2,659.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,575.67 / $3,185.64
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,440.69 / $2,440.69 / $2,440.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,440.69 / $2,440.69 / $2,440.69